GLP-1 agonists, initially developed for treatment of Type 2 diabetes, are now all the rage for treatment of obesity. Tirzepatide, marketing as Zepbound, is now entering the mix as an FDA-approved tool in the weight loss tool box. Early results show remarkable clinical effects on weight and other health factors. However, the drugs are very expensive, sometimes not covered by insurance (including Medicare), and plagued by shortages.
Much has been and will continue to be written about this hot new area of medicine. The emergency medicine community needs to be aware of the good and bad of this drug class. One study in JAMA documents at a population level rare but serious side effects including pancreatitis, gastroparesis, and bowel obstruction. More will be written documenting what we learn about this drugs.
What do we need to know? First, many of our patients are on these drugs. They may get them from primary care providers, or increasingly may get them prescribed from telemedicine providers. These injectable meds may or may not be used correctly, and side effects are expected. Many patients will have nausea, diarrhea, or other effects of changes in gastrointestinal motility. The anesthesiology community has reported some cases of full stomachs well past normal NPO guidelines. EMcentric will publish a broader review of obesity management in the coming weeks.
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